19-105224 Electrical
City of Federal Way Permit #:19-105224-00-EL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: MILLER
Project Address: 33729 37TH PL SW Parcel Number:921151 0120
Project Description: Installation of electric under-floor heating system w/GFI in lower bath/laundry;installation of
(3)GFIs for bathroom.
Owner Applicant Contractor
ANDREA MILLER ANDREA MILLER OWNER IS CONTRACTOR
33729 37TH PL SW 33729 37TH PL SW
FEDERAL WAY WA 98023-2958 FEDERAL WAY WA 98023-2958
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
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Circuits-Residential 4
PERMIT EXPIRES Thursday,29 October,2020
Permit Issued on Wednesday,October 30,2019
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of
Washington and the City of Federal Way.
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Owner or agent:�' �`���' 't��� — — Date: `� 0C q
THIS CARD IS TO REMAIN ON-SITE
FeCITY deral WayConstruction Inspection Record
INSPECTION REQUESTS: (253)835-3050
PERMIT#: 19 105224 00 Address: 33729 37TH PL SW
Project: ANDREA MILLER FEDERAL WAY WA 98023-2958
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible
(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if
you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
0 UFER Ground(4295) `•0 Ditch cover(4030) •'•0 Slab/Concrete Floor(4255) '
Approved Approved Approved to place concrete
By Date By Date By Date
® Pool Bonding(4195) •',El Temporary Power(4275) •�® Service(4235)
Approved Approved Approved
By Date By Date By Date
,® Feeders/Sub-panels(4045) 0 RoughElectrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By e„, Date// J'.JBYDate
El Final-Electrical(4055)
` Approved
By Date/ go if
Rough Electrical El Final Electrical El Right of Way
Approved Approved
Approved
By Date By Date
By Date
1111111
441/4. RECEIVED ELECTRICAL
CITY OF 111111 1/
Federal Way OCT 3 0 2019 PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEV �j ELO� / 9 - / D S l 7 j
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NUMBER
DDRESS' �, ' A SUITE/UNIT/SPACE#
SITE A
33'0)a 21 0_, s>�, c-eb (.tiA, GO9 3
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 1, SOo' 9 2 11 / 5 1 - 0 ( --
PROJECT NAME \"y\
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION iA1N "(- ���"C (*Ala l'"1 ' w5 f wd-Y✓ 4 \ -c' v
Detailed description of work to Oc- ��,,,,N J Lu,a,n4V J f 044-1,1 .
be included on this permit only J
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NAME PRIMARY PHONE
PROPERTY OWNER A49-- Cern A La/rt.D (o 3 ) W(0=-3 C) (
MAILING ADDRESS E-MAIL
ITY STATEL4roi
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NiM E PRIMARY PHONE
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MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
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WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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PRIMARY PHONE
APPLICANT Cj(ti C- \�� " )W(0- 2 57 I
MAILING ADDRESS E-MAIL
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PROJECT CONTACT U,e , i; ( .S 1)9a I --cls---1
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred in
the investigation and defense of such claim), which may be made by any person,including the undersigned,and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a of this application.
7
SIGNATURE: rilf., k(_. DATE 1 o Ili f
PRINT NAME: ( tn6k V‘\.\ \\
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
CITY OF Property Owner
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Federal Way Electrical Work Permit Application
Applying For Your Electrical Permit
In Washington, only licensed electrical contractors may perform electrical work. Property owners
may apply for an exemption from these requirements by completing this application and signing
the affidavit below before beginning electrical work.
•
As authorized under RCW 19.28.261, I, A'(\�,(\et,k, \\P hereby apply'
(Printed name of property owner,renter,or lessee)
for an exemption from the electrical licensing and certification requirements of RCW 19.28 by
submission of this affidavit.
ii
Which'statement-;describes you? (Mark only one if none apply.,you"rttay not'take out this 11),;;;:"f,' IF
Or I own this property.
Your name or your company's name must be shown on the deed to the property. Real estate agents'property
management companies, relatives, etc. cannot purchase permits for the property owner.
❑ I rent or lease this property.
We need a copy of your rental agreement showing you have permission to perform electrical work
❑ I am an officer for a 501(c)(3)nonprofit corporation,or a nonprofit religious organization.
( The total market value of electrical work must be$30,000 or less and all electrical work must be done by a
non-compensated appropriately certified electrician. t'
Select your property_type(Mark only one If none apply,you may not take out this permit.)
I ❑ New single family residence that is not intended for rent, sale, or lease,where I will be living for
at least 24 months after completing the electrical work. I will be personally doing the electrical
work.
❑ New 2,3,or 4 unit residential building,owned by me,that is intended for rent, sale, or lease. I
will be living in one of the units for at least 24 months after completing electrical work. I,
personally, and/or a regularly employed employee(s),will be doing the electricalwork.
❑ New place of business,farm,or other property: Any new structure that is not intended for rent,
sale, or lease. I,personally,and/or a regularly employed employee(s),will be doing the electrical work.
3 ® Existing residential property, place of business,or farm.I, personally,and/or a regularly tg
{
employed employee(t),will be doing the electrical work.
z ¢
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 www.cityoffederalway.com zs permitcentert cityoffederalway.com
Bulletin 11080-June 6,2018 Page 1 of 2 k:\Handouts\Property Owner Electrical Work Application
14,1"--
❑ 501(c)(3) or nonprofit religious organization owned property:The total market value of the
electrical work must be$30,000 or less,and all electrical work will be performed by appropriately
certified electricians,or certified and properly supervised trainees, who are volunteering and not
being compensated for the electrical work per RCW 19.28.091(7).
Your signature is required below:
I believe I should be exempt from the requirements to obtain an electrical license,or use a certified
electrician,as provided under RCW 19.28.261.
By signing below,I certify the information I am providing on this affidavit is true and accurate. I
understand that if I make false statements or misrepresentations, I may be assessed penalties.
AV\&(\e-k M+ \\-Qr AVX,e4't, -./".-k r—_-
Printed Name of Property Owner,Renter,or Lessee Signature
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Date
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'�ropet flvvnef- a-nd nspetioli'S-i e4nformation E
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Property Owner's Name(Last,First)or Company Name
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Mailing Address • UnitlApt.# City State Zip -
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Daytime Phone Email Address
• Inspection Site Address(if different) UnitlApt.# City State Zip
County Electrical Power Company/Serving Utility
Description of work being done{Example:adding outlets in thekitchen;second floor breakarea,etc:)
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DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 zs www.cityoffederalway.com permitcenterto'�,cityoffederalway.com
Bulletin#080—June 6,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Application